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H 845.1 I61b 2011 c.2
Intervals between Live Vaccines and Other Rules
All vaccines can be administered simultaneously (on the same day).
2 Live Vaccines
Live vaccines can be given on the same day. If they are not given on the same day, they should be
separated by a minimum 4-week interval, because the immune response to one of the vaccines
might be impaired. If two live vaccines are not given on the same day and are given less than
four weeks apart, the second vaccine should be repeated. Alternatively, the effectiveness of
the second vaccine can be checked by serologic testing.
H
Don't do this
less than 4 weeks
at least 4 weeks
This applies to MMR,
varicella, zoster,
yellow fever vaccines
& LAIV; but, it does
not apply to oral
typhoid and rotavirus
vaccines.
Inactivated vaccines do not interfere with live vaccines and live vaccines do not interfere with
inactivated vaccines. An inactivated vaccine can be administered either simultaneously or at
any time before or after a different inactivated or live vaccine. A live vaccine can be given
either simultaneously or at any time before or after an inactivated vaccine.
Spacing of Vaccines and Antibody-Containing Products
Blood and other antibody containing blood products can inhibit the immune response to measles
and rubella vaccines for 3 or more months because these products contain antibodies to measles
and rubella viruses. In theory, the same is true for rotavirus vaccines, but no data is available and
children will receive 2 or 3 doses of rotavirus vaccine. The effect of IG on the response to mumps
and varicella vaccines is unknown, but IG products contain antibodies to these viruses and the
same intervals as for measles vaccine should be followed for varicella vaccine.
After an antibody-containing product is received, live vaccines (except rotavirus, zoster, live
attenuated influenza vaccine (LAIV- FluMist®), yellow fever, and oral typhoid vaccines) should be
delayed until the passive antibody has degraded. For specific intervals, refer to the Antibody-Live
Vaccine Interval Table in Appendix A of the Pink Book at CDC's vaccines website:
http://www.cdc.qov/vaccines/pubs/pinkbook/downloads/appendices/A/mmr iq.pdf.
MMR & TB Skin Testing
Natural measles infection exacerbates tuberculosis. Measles vaccine (and possibly mumps,
rubella, and varicella vaccines) may temporarily suppress the response to tuberculin skin testing
(TST) in a person infected with Mycobacterium tuberculosis. Options:
• Apply TST at the same visit as MMR
• Delay TST at least 4 weeks if MMR has already been given
• Apply TST first and administer MMR when skin test is read
The third option is the least favored option because it delays receipt of MMR.
Protect from Light
Immunization Service
Oklahoma State
Department of Health
Live vaccines
contain a live
vaccine virus that
must replicate in the
body in order to
stimulate immunity.
Anything that
interferes with that
replication might
impact the immune
response.
Remember:
Live vaccines can be
given on the same
day.
The 4-day grace
period does not
apply to the 4-week
minimum interval
between 2 different
live vaccines.
It does apply to the
4-week minimum
interval between
doses of the same
live vaccine, such as
the 4 weeks between
MMR1 and MMR 2.
It is always best to
follow the
recommended
schedule as closely
as possible.
Vaccine
administration at the
recommended ages
and intervals
provides optimal
protection.
Live vaccines must still be alive when they are injected or they won't replicate. Light inactivates or kills some live vaccines,
including MMR, varicella, zoster, and rotavirus vaccines, so these vaccines must be protected from light. Also, Menveo,
meningococcal conjugate vaccine, and HPV vaccines (Gardasil and Cervarix) must be protected from light, even though they
are not live vaccines.
This publication is issued by the Oklahoma State Department of Health as authorized by Terry L. Cline, PhD, Commissioner of Health. 1000 copies have been
printed at a cost of $150.00. Copies have been deposited with the Publications Clearinghouse of the Oklahoma Department of Libraries. 8-4-2011

H 845.1 I61b 2011 c.2
Intervals between Live Vaccines and Other Rules
All vaccines can be administered simultaneously (on the same day).
2 Live Vaccines
Live vaccines can be given on the same day. If they are not given on the same day, they should be
separated by a minimum 4-week interval, because the immune response to one of the vaccines
might be impaired. If two live vaccines are not given on the same day and are given less than
four weeks apart, the second vaccine should be repeated. Alternatively, the effectiveness of
the second vaccine can be checked by serologic testing.
H
Don't do this
less than 4 weeks
at least 4 weeks
This applies to MMR,
varicella, zoster,
yellow fever vaccines
& LAIV; but, it does
not apply to oral
typhoid and rotavirus
vaccines.
Inactivated vaccines do not interfere with live vaccines and live vaccines do not interfere with
inactivated vaccines. An inactivated vaccine can be administered either simultaneously or at
any time before or after a different inactivated or live vaccine. A live vaccine can be given
either simultaneously or at any time before or after an inactivated vaccine.
Spacing of Vaccines and Antibody-Containing Products
Blood and other antibody containing blood products can inhibit the immune response to measles
and rubella vaccines for 3 or more months because these products contain antibodies to measles
and rubella viruses. In theory, the same is true for rotavirus vaccines, but no data is available and
children will receive 2 or 3 doses of rotavirus vaccine. The effect of IG on the response to mumps
and varicella vaccines is unknown, but IG products contain antibodies to these viruses and the
same intervals as for measles vaccine should be followed for varicella vaccine.
After an antibody-containing product is received, live vaccines (except rotavirus, zoster, live
attenuated influenza vaccine (LAIV- FluMist®), yellow fever, and oral typhoid vaccines) should be
delayed until the passive antibody has degraded. For specific intervals, refer to the Antibody-Live
Vaccine Interval Table in Appendix A of the Pink Book at CDC's vaccines website:
http://www.cdc.qov/vaccines/pubs/pinkbook/downloads/appendices/A/mmr iq.pdf.
MMR & TB Skin Testing
Natural measles infection exacerbates tuberculosis. Measles vaccine (and possibly mumps,
rubella, and varicella vaccines) may temporarily suppress the response to tuberculin skin testing
(TST) in a person infected with Mycobacterium tuberculosis. Options:
• Apply TST at the same visit as MMR
• Delay TST at least 4 weeks if MMR has already been given
• Apply TST first and administer MMR when skin test is read
The third option is the least favored option because it delays receipt of MMR.
Protect from Light
Immunization Service
Oklahoma State
Department of Health
Live vaccines
contain a live
vaccine virus that
must replicate in the
body in order to
stimulate immunity.
Anything that
interferes with that
replication might
impact the immune
response.
Remember:
Live vaccines can be
given on the same
day.
The 4-day grace
period does not
apply to the 4-week
minimum interval
between 2 different
live vaccines.
It does apply to the
4-week minimum
interval between
doses of the same
live vaccine, such as
the 4 weeks between
MMR1 and MMR 2.
It is always best to
follow the
recommended
schedule as closely
as possible.
Vaccine
administration at the
recommended ages
and intervals
provides optimal
protection.
Live vaccines must still be alive when they are injected or they won't replicate. Light inactivates or kills some live vaccines,
including MMR, varicella, zoster, and rotavirus vaccines, so these vaccines must be protected from light. Also, Menveo,
meningococcal conjugate vaccine, and HPV vaccines (Gardasil and Cervarix) must be protected from light, even though they
are not live vaccines.
This publication is issued by the Oklahoma State Department of Health as authorized by Terry L. Cline, PhD, Commissioner of Health. 1000 copies have been
printed at a cost of $150.00. Copies have been deposited with the Publications Clearinghouse of the Oklahoma Department of Libraries. 8-4-2011